Kansas Board of Healing Arts Complaint Process

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The Kansas Board of Healing Arts (“the Board”) has an established procedure for investigating and adjudicating complaints of wrongdoing lodged against one of its members. The procedure is a natural progression from intake of complaint to investigation and either closure of the investigation or adjudication. Each step in the process is critical to both the complainant and the health care provider under investigation. Any caregiver who learns of an investigation must retain counsel as soon as possible. Failure to hire counsel timely could have dire consequences and lead to disciplinary action that may have been avoided. Kansas professional licensing attorney Danielle Sanger will zealously fight to protect your professional license from discipline.

The Board has developed a standardized procedure to handle complaints against its members. Most commonly, complaints are filed by patients. The Board may receive a complaint from any number of sources. However, information from complaints may be forwarded by other healthcare agencies, other healthcare providers, data bank reports, malpractice information, and adverse findings from other licensing boards. Once that happens, the complaint is added to the Board’s complaint database and is forwarded to disciplinary counsel. Disciplinary counsel reviews the complaint to determine whether the disclosed allegations may violate the Healing Arts Act. If disciplinary counsel determines that there is no violation of the Healing Arts Act based upon the factual allegations in the complaint, then the complaint is closed and no further action on the complaint is taken. At that point, the complaint is forwarded to an investigator for closer examination and investigation.

The assigned investigator is responsible for gathering information from various sources. The investigator will accumulate records from the licensee and all other relevant agencies. The investigator will also interview several individuals, if warranted, by the investigation. The investigator may interview the licensee or at least try to obtain a response to the allegations. The investigator should speak with patients, complainants, and other witnesses who may possess relevant information. The matter is referred back to disciplinary counsel when the investigation is complete.

Disciplinary counsel reviews the investigation to determine whether the complaint should proceed. If the complaint lacks support from “credible evidence” and the allegations are unsupported, then the complaint may be closed. At this juncture, the process proceeds toward adjudication if the complaint is supported by competent evidence.
The path the matter takes to adjudication depends upon the nature of the proceedings. If the complaint is based upon a violation of the standard of care, then the disciplinary counsel forwards it to the complaint review committee or professional council. Standard-of-care issues are reviewed by practitioners from the same profession or initial peer-review board. Conduct issues are those that do not involve an alleged breach of the standard of care. Conduct issues include the business of medical practice, practicing without a license, billing issues/complaints, practice by an impaired healthcare professional, and criminal convictions. Conduct issues are referred to litigation counsel by the Board. If the review board or committee determines the matter should proceed, then disciplinary counsel refers the matter to the disciplinary panel.

The disciplinary panel makes a recommendation to initiate discipline or close the case. The recommendation to close or initiate discipline is reviewed by the Board. Each level of review is independent of the previous and is not bound by those decisions. Initiating disciplinary action may take the form of a professional development plan or letter of public concern. The licensee may also agree to a resolution such as a consent order. The licensee may also contest the panel’s recommendation. The Board ultimately reviews and may approve all actions by the disciplinary panel. The Board may also seek further review of closed matters.

Protect Your Livelihood
Kansas Professional Licensing Attorney Danielle Sanger will vigorously fight to protect your ability to make a living. She understands the sacrifices made to achieve professional licenses and the devastation discipline can cause. Do not go it alone. Call Attorney Sanger today at 785-979-4353 to schedule your free consultation.

Kansas State Board of Healing Arts and Board of Nursing Collaborate On Pain Management Initiative

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In February of 2016, two critical policy-making agencies collaborated to revise their approach to combating opioid addiction in Kansas. Delegates from Kansas’s State Board of Healing Arts and the Board of Nursing met to discuss a proposed redrafting of a “Joint Pain Management Policy.” The draft serves as an attempt to devise pain management plans that address each patient’s individual needs while countenancing and interdicting addictive behavior. The draft purports to expand the health care provider’s role in administering pain medication to impose greater oversight over the patient’s treatment with opioids.  Any health care provider licensed by either Board is now on notice that each respective licensing authority is carefully monitoring narcotics dispensing practices. A breach of this policy may result in disciplinary action. Kansas professional licensing attorney Danielle Sanger advises all of her clients to carefully monitor their opioid dispensing practice consistent with a health care provider’s duty of care.

The current Joint Pain Management Policy promulgated by the State Board of Healing Arts and the Board of Nursing was issued in 2002. Since that time, opioid abuse and addiction has spiked to levels heretofore unseen, not only in Kansas but nationwide. Accordingly, the Boards have undertaken the responsibility to craft a new policy that addresses the new reality of opioid addiction. The most recent draft of the policy circulated by the Boards emphasizes appropriate pain management for the individual patient by a team of health care providers. One of the problems facing health care providers today is the treatment of chronic and/or acute pain. The Boards recognize that many patients’ pain is improperly managed due to under- or over-prescription, or ineffective treatment. Because the reporting of symptoms of pain is subjective, the Board strives to balance the appropriate treatment of pain with the specter of drug-seeking and addictive behavior.

The Board proposes that health care providers should be wary of potential drug-seeking behavior. Recognizing the risks and the benefits of opioid prescription is critical to appropriately addressing a patient’s pain management. Health care professionals must be aware of the dangers that inure to long-term opioid use. These complications include addiction and abuse of the medication. Health care providers must understand that a patient may need opioid medication to combat pain and that a request for an increased dose is not necessary a symptom of drug dependency. It is therefore incumbent upon the health care provider to understand the signs of addictive behaviors and address those accordingly.

The draft emphasizes the growing need to investigate health care professionals who “treat pain inappropriately.” While proper investigation is necessary, the draft is very clear that a request for information concerning prescription practices does not equate with a formal complaint. To be sure, the draft stipulates that prior to filing of any allegations the information gathered during the investigation will be subject to peer review and health care providers should not “fear disciplinary actions” if they appropriately manage their patients’ pain.

Interestingly, the draft policy purports to not create a new standard of practice or claim to be a so-called “best practice.” However, the Boards’ stated intention is to delineate practices that are “within the boundaries” of professional practice and is not designed to usurp a health care provider’s judgment exercised consistent with a competent health care provider. Disclaimer notwithstanding, the Boards counsel that patients must be individually assessed for pain level, tolerance, and likelihood of recovery, and that instruments should be used to obtain an objective pain threshold. Additionally, the patient must be evaluated to determine whether the patient is a candidate to abuse prescribed narcotics. The use of baseline testing is recommended. The Board recommends using a written treatment plan and that every patient should have one health care provider who controls prescribing pain medication. The Boards counsel utilizing a written agreement with the patient who will agree to be strictly monitored while on prescribed narcotics.

Whom To Call For Help

Call Kansas professional licensing attorney Danielle Sanger if you are under investigation for dispensing pain medication. Despite claims to the contrary, an investigation into your medical practice is never meaningless.  Kansas Professional Licensing Defense Attorney Sanger has the experience to vigorously defend your rights and defend you against allegations of wrong-doing. Call Attorney Sanger today at 789-979-4353 to schedule your free consultation.

Kansas Amends The Healing Arts Statute

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The Kansas legislature amended the Healing Arts Statute in 2015. The statutory amendments are designed to address certain failings of the previous statutory provisions. Furthermore, the amended sections align statutory regulations with the reality of the practice of medicine today.  The amendments impose more severe criminal punishments for practicing medicine without a license as well as augments the rules governing unprofessional conduct exposing a practitioner to potential licensing discipline.  Kansas professional licensing attorney Danielle Sanger counsels practitioners of the healing arts in Kansas to become well versed in the changes in the law and to be wary of conduct potentially subjecting oneself to discipline.

The statutory amendments cover a wide range of conduct. At the outset, the definition of healing arts was expanded to include medical treatment with the purpose of “alteration or enhancement of a condition or appearance.”  Additionally, the criminal penalty for practicing a healing art without a license—be it suspended, revoked, or otherwise—was increased from a Class B misdemeanor to a Level 10, non-person felony. This crime carries the potential for imprisonment of up to 6 months and probation for at least 12 months. The statute also authorized a more severe civil penalty of $1,000 per day for practicing without a license. The costs of prosecution may be included in addition to the daily fine. The Board of Healing Arts is permitted to seek an injunction against any person found to be practicing medicine without a license as well.

Significantly, the statutory amendments introduced new grounds for disciplinary action. The amendments added two criminal dispositions to the list of criminal dispositions presumptively mandating discipline. A conviction by either a special or a general court martial irrespective of a conviction of a Class A misdemeanor or felony or a similar crime in another jurisdiction will now warrant discipline. The amendment created the presumption of revocation following the conviction of a felony or like offense in another jurisdiction and for a conviction at a general court martial. The Board may decline to revoke if the Board determines by 2/3 vote that the practitioner is not a danger to anyone and that the person has been rehabilitated so as to not violate the public trust.

The statutory amendments also reflect the growing need to monitor health care professionals who are suffering an inability to competently practice a healing art. The amendments alter the language of the previous statute. Ostensibly in an effort to maintain the public trust, the previous safeguards afforded to the professions have been omitted. The statute now reads the “licensee’s ability … is impaired” by illness or drugs.  The previous statutory language referred to the licensee’s inability to practice. All documents obtained through an investigation shall remain confidential and will not be released to anyone for any purpose other than by use for the Board.

The amendments expanded upon the definition of professional incompetence. Interfering with a Board investigation is now included within that definition. Acts considered obstructing or interfering are

  1. falsifying or concealing a material fact;
  2. knowingly making or causing to be made any false or misleading statement or writing; or
  3. other acts or conduct likely to deceive or defraud the Board.

Furthermore, the newly passed statute has revised certain aspects of disciplinary procedure for licensees. The amendment expands the professional designations subject to discipline from merely licensees to include registrants, certificate holders, and permit holders. These additional professional designations may receive the benefit of a professional development plan in lieu of discipline. All of these professions are also subject to the Board of Healing Art’s subpoena power. This power was expanded to have the authority to compel production of evidence if the person previously failed to comply with a subpoena. The person subpoenaed may contest the subpoena but must first rely on the administrative remedy of appealing to the Board prior to appealing the ruling to the district court. Importantly, every person practicing a healing art is now obligated to report a violation of the law related to practicing the healing arts to the Board of which they have knowledge.

Consult An Experienced Professional Licensing Attorney For More Information

 Kansas Professional License Defense Lawyer Danielle Sanger is a dedicated advocate for all practitioners of the healing arts. She will vigorously and zealously fight to protect your livelihood. Call Attorney Sanger today at 785-979-4353 for your free consultation.

 

Recently Enacted Statute Permits Collaborative Practice Arrangements

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A recently enacted bill allows medical school graduates to practice medicine in collaboration with supervising physicians. The statute, known as Section 334.036, permits assistant physicians to practice medicine in rural or underserved locations in Missouri. The law facilitates delivery of health care services to citizens who have little or no opportunity to avail themselves of quality health care while providing aspiring physicians with a forum for practical skill development. The law delineates the practices an assisting physician may undertake as well as identifies the ethical responsibilities of the assisting physician and supervising physician. Missouri professional licensing attorney Danielle Sanger advises that physicians who agree to supervise a student physician under a collaborative practice arrangement must familiarize themselves with the requisite ethical standards to avoid potential pitfalls.

An assistant physician may practice medicine only in compliance with strict adherence to established guidelines. An assistant physician must be licensed in Missouri. An applicant must have graduated from medical school and be a citizen of the United State or a legal alien. Moreover, the applicant must have successfully completed Steps 1 and 2 of the United States Medical Licensing Examination within two years of applying to become an assistant physician.  However, the applicant is ineligible if applying to be an assistant physician more than three  years after graduation. A person is also eligible to apply if the postgraduate residency has not been completed but has passed Step 2. Moreover, the applicant must be fluent in English.

The assistant physician is limited in practice. The assistant physician’s medical practice is limited to primary care in rural or underserved areas or as part of a pilot project area. The assistant physician may self-identify as an assistant physician but is permitted to use the terms “doctor” or “doc.”  The assistant may administer medical treatment in an emergency situation; however, the practice of medicine is prohibited unless the assistant physician is a signatory to a collaborative practice arrangement with a supervising physician. The assistant physician may prescribe narcotics listed in Schedules III, IV, and V of Section 195.017 once they properly obtain a certificate to prescribe drugs and have appropriate registrations filed with the Federal Drug Administration as well as the Missouri bureau of dangerous drugs. The assistant may only prescribe medications listed in Schedule II if the medication contains hydrocodone and the prescription is limited to a five-day course. Moreover, the assistant physician may not prescribe medication for personal use or to members of their families.

A collaborative practice arrangement must be executed between assistant physician and supervising physician. To be valid, the collaborative practice agreement must be in writing and contain agreed-upon protocols or “standing orders for the delivery of medical services.”  In addition, the collaborative practice agreement can give the assistant physician authority to administer treatment and write prescriptions, consistent with statutory limitations, provided that the care administered is consistent with the assistant physician’s skills, training, and experience. The arrangement must include a provision indicating that a notice shall be displayed in the physician’s office including a list of prescriptions the assistant physician may prescribe and a notice that the patient may be seen by an assistant physician. The notice must include a statement that the patient has the right to be examined by a physician and not the assistant.

The collaborating physician has many obligations when undertaking the role of supervising physician.  The supervising physician must review a minimum of 10 percent of the assistant physician’s charts every 14 days. Additionally, the collaborating physician must review a minimum of 20 percent of the assistant’s charts in which prescriptions were written.  Moreover, the collaborating physician must document a one-month time frame during which the assistant practices exclusively with the collaborating physician before the assistant can see patients alone.  Additionally, the assistant must practice with the collaborating physician for 120 hours in a four-month period before the assistant is permitted to prescribe medications.

Attention To Detail Will Prevent Disciplinary Action

The assistant physician is practicing medicine on the license of the collaborating physician. Any ethical transgressions committed by the assistant may be attributed to the collaborating physician. Contact Missouri Professional Licensing Attorney Danielle Sanger at 785-979-4353 to schedule a no-obligation consultation to discuss disciplinary issues you face as a result of a collaborative practice arrangement.

Physician Assistants In Kansas Must Be Aware Of New Regulations

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On January 11, 2016, amendments to the regulations governing physician assistants in Kansas became effective. Generally speaking, the new regulations permit greater flexibility to physician assistants in some aspects while placing greater responsibility on the attending physician. The goal of the amendments is better patient care. Being aware of the changes is vitally important to both the physician and the physician’s assistant. Failing to follow the new changes may jeopardize your physician assistant’s license. Kansas professional licensing attorney Danielle Sanger stakes her reputation on fighting for licensees who are facing the specter of discipline.

The new amendments to the regulations governing physician assistants introduce a series of definitions for terms of art currently used in the profession to describe the relationship between a physician’s assistant and the supervising physician. For instance, the amendments define “supervision” as overseeing delegated medical care to the physician’s assistant. A substitute supervising physician is defined as the physician who agrees to take a supervisory role of the physician’s assistant when the primary supervising physician is unavailable. The phrase “different practice location” is a place where medical treatment is dispensed to patients where the supervising physician or substitute supervising physician practices less than 20% of the time. A medical care facility is exempted from this definition. “Direct supervision” is defined in the amendments as the supervising or substitute supervising physician being physically present and able to take over immediate care of the patient if so required. This is in contrast to the situation when the supervising physician is communicating with the physician’s assistant telephonically or via electronic communication.  That method of supervision is defined as “off-site supervision.” However, “indirect supervision” means that the supervising physician or substitute supervising physician can be on site to take over care of the patient in 15 minutes or less.

The amendments to the regulations define the limits on the scope of a physician assistant’s practice. The regulations allow a physician assistant to administer medical treatment to a patient when the supervising physician or substitute supervising physician authorizes and coordinates such treatment when the supervisor is physically present.  The physician assistant is also allowed to treat a patient when authorized and coordinated with the supervisor through “verbal or electronic communication.” The physician assistant may also render care to a patient consistent with the active practice request form which is required to be filed with the Kansas Board of Healing Arts. Lastly, the physician assistant may medically treat a patient in an emergency situation.

The physician assistant must file an active practice request form with the Kansas Board of Healing Arts. The physician assistant must disclose a significant amount of information on the active practice request form. Information such as identifying supervising and substitute supervising physicians, a disclosure of the nature of the medical services to be provided, and whether the supervising physicians will be present at the same location as the physician assistant. If not, the physician assistant must state that they have practiced at least 80 hours under the direct supervision of the supervising physician. The physician assistant and the supervising physician must also file a written agreement with the active practice request form. The agreement must contain a list of services the physician assistant may and may not perform. A list of prescription drugs the physician assistant is authorized to dispense must also be included in the agreement.  The practice request form must also memorialize the physician’s and substitute physician’s consent to be available for communication with the physician assistant during business hours.  It is important to note that the active request form must be filed with the Kansas Board of Healing Arts on or before July 1, 2016.

For More Information, Contact the Sanger Law Office Now

Keeping current in your field of practice is vital to satisfying the ethical standards of a physician assistant. It is critical, therefore, that you read and understand your obligations as a physician assistant. Kansas Professional Licensing Attorney Danielle Sanger advises physician assistants and other medical arts practitioners. Call Attorney Sanger today at 785-979-4353 for your no-obligation consultation.

Vicarious Liability Can Lead To Ethical Violations

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Professional engineers who affix their seal to plans for a structure must proceed with caution. The engineer may become liable for subordinates’ or other licensees’ mistakes. Therefore, professional engineers must take every precaution to make certain that subordinates’ plans as well as plans drafted by other licensees satisfy the standards in the profession. Failure to do so may have disastrous results, including revocation of license, suspension, probation, or censure. Missouri professional licensing attorney Danielle Sanger possesses vast experience in defending professional licensees whose ethical violations are based upon vicarious liability.

One of the greatest engineering tragedies occurred in Missouri. On July 17, 1981, the fourth and second floor walkways collapsed in the Hyatt Hotel. There were approximately 2000 people present. The collapse killed 114 and injured 186. At the time, this was the costliest structural collapse in United States’ history in terms of lives lost.  The Missouri Board of Architects, Professional Engineers, and Land Surveyors (“the Board”) instituted disciplinary action against the engineer in charge of the project. The engineer, Gillum, was found vicariously liable for the “acts and omissions” of another engineer when he affixed his seal to the plans, thus signifying his approval of the final construction plans.  Gillum was also found grossly negligent for not reviewing the subordinate engineer’s plans personally.

Gillum appealed the ruling. He argued that he cannot be found vicariously liable for another engineer’s actions. The appeals court disagreed. The court held that vicarious liability is based upon the relationship of the parties and, as a matter of public policy, one party is responsible for the “acts or omissions” of the other party. This holds true even if there is no wrongdoing on behalf of the party found to be vicariously liable. The court found that Gillum could not delegate his duty to ensure a structurally sound building once he affixed his seal to the plans. Thus, Gillum assumed responsibility of the entire project by signing off on the plans without a specific disclaimer.  The court stated that the thrust of disciplinary action is not necessarily punishment but rather protection of the public.  Accordingly, the disciplinary action levied against Gillum was appropriate for the subordinate engineer’s negligence.

Vicarious liability does not attach in every circumstance despite the engineer affixing his seal. The Missouri Supreme Court vacated the Board’s finding of suspension against an engineer, Bird, who approved final plans with his seal. The Missouri Supreme Court held that, upon review of the record, Bird discharged his duty as he was obligated to by statute. Bird was hired by a firm to complete a project and submit final plans after the firm had a financial dispute with the architect they initially hired for the project. The architect refused to place his seal on the plans. Bird reviewed all of the plans, performed the appropriate computations, and made the necessary changes to the plans. Bird affixed his seal approving the entire project.

The Board found that Bird failed to supervise the original architect and therefore was subject to discipline. The Missouri Supreme Court disagreed. The Court held that the statute merely delineated personal responsibility to Bird for the project and does not obligate one licensee to supervise another licensee. In reaching that conclusion, the Missouri Supreme Court stated that an engineer is only responsible for the work of an unlicensed person who is directly supervised by the engineer and not another licensee. Therefore, the Court found that Bird did not violate the licensing statute and was not subject to discipline.

Experience Generates Results

Kansas Professional licensing Attorney Danielle Sanger, with offices in Missouri and Kansas, understands the stress of facing a complaint levied by a licensing board. Attorney Sanger is a seasoned professional licensing attorney who will fight to protect your professional license that is the essence of your livelihood. Call Attorney Danielle Sanger today at 785-979-4353 to learn the difference experience will make for you.

Duty To Warn: Disclosure Versus Privacy In Missouri

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Medical professionals must learn very private details of their patients’ lives to properly treat them. Likewise, patients must trust their physicians with intimate and private information so they get the care they deserve. Both patient and care giver understand and rely upon the confidentiality which is essential to proper medical care. In the ordinary case, medical professionals will jealously guard their duty. The duty of maintaining confidentiality or privilege, depending upon the nature of the care provided, on its face, appears to be a bright-line rule. Can the circle of trust be broken without committing an ethical violation in Missouri? The answer depends upon the facts of the individual case.  Therefore, if you find yourself in that position, it is crucial that you contact Missouri professional licensing attorney Danielle Sanger for a thorough analysis of the situation.

In Missouri, a “mental health coordinator” has a duty imposed by statute to take action if they receive information that a person is about to commit a “serious harm.” The threat must arise from a “mental disorder.” In that instance, the statute requires the mental health coordinator to conduct an investigation, analyze the data acquired during the investigation, then evaluate the credibility of the sources of the information. At that point, the coordinator must determine whether a threat to do serious bodily harm exists. If there is reasonable cause to believe the patient will hurt himself or someone else, then the mental health professional must contact the local probate court for an order to apprehend the individual. If the professional believes that the threat is imminent, the coordinator may seek police assistance in apprehending the person and commit them involuntarily. Lastly, the statute imposes a duty upon the coordinator to notify the patient’s family and friends about available services if an involuntary commitment is not indicated.

The above procedure, if followed, can thwart a threat to a specific person or group of people. The statute is silent as to whether the target of the threat must be notified. Notwithstanding, Missouri may impose a “common law” duty to warn the potential target of the threat. Failure to discharge that duty may have adverse professional consequences. The existence of a duty to warn rests on several factors. Those factors include the public policy of Missouri in preventing the harm alleged, the foreseeability of the potential harm and the ability to protect against it, the moral blame associated with the harm, and the societal costs to the “actor and the community.” The right to sue for failure to warn extends only to identifiable potential victims and not the community at large. The cost to the provider is minimal. Discharging the duty to warn may be as simple as a telephone call to the police or other appropriate authority, and the object of the threat.

The duty to warn may attach to more than mental health professionals. Generally speaking, Missouri does not impose a duty to warn upon the average person to prevent a third party from becoming a victim of a crime. In that instance, liability does not attach to the person who could have prevented the harm. Notwithstanding, the nature of the relationship between care giver and patient can impose the duty to warn a third party about impending harm. The harm, however, must not be remote. It must be foreseeable. Foreseeable means whether the reasonable person knew or should have known about the potential danger and taken some measure to stop it.

Seek Immediate Legal Assistance If You Find Yourself In This Situation

No medical professional wants to find themselves in this situation. Missouri Professional Licensing Attorney Danielle Sanger recommends that you follow the appropriate steps to discharge your duty and document as much information as you can. Attorney Sanger will rely on that information to vigorously defend you if adverse legal action is taken against you because of your decision. Call Missouri professional licensing attorney Danielle Sanger today for a free, no-obligation consultation at 785-979-4353.

Kansas Professional Licensing Attorney Explains Administrative Appeals

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Adverse action against a professional license can be appealed to a higher court for review. In Kansas, an administrative law judge makes findings and rulings at a hearing. The administrative law judge’s findings of fact and rulings of law must be based upon the evidence produced by the licensing authority at a hearing.  The licensee may accept the findings of the administrative law judge or appeal. The case is not heard all over again. Rather, the reviewing judge, usually a district court judge, will review the record generated by the investigation and hearing before the administrative law judge to ensure that the administrative law judge’s decision complied with Kansas law.  Kansas professional licensing attorney Danielle Sanger has vast experience in representing professional licensees in adversarial actions at the administrative level and on appeal.

In Kansas, the licensing authority has the burden of proving the allegations against the licensee. The administrative law judge must find the licensing authority has proved its case with substantial competent evidence to take adverse action against the licensee.  On appeal, the party with the burden of proof changes. The party asserting the error must prove that the ruling was wrong and its decision was “arbitrary and capricious.” The reviewing court will not hear new evidence. The reviewing court must accept the findings of fact found by the administrative law judge if the facts are “supported by substantial competent evidence.” “Substantial competent evidence” has been defined by Kansas courts as evidence that is relevant and provides a “substantial basis” to resolve the contested issues. The prevailing party is entitled to deference on the facts if the facts of the case are disputed on appeal to determine if the facts are supported by substantial competent evidence.” The court does not re-evaluate the evidence. However, the issues of law as decided by the administrative law judge are reviewed de novo by the appellate judge.

With those guidelines the reviewing court will only reverse the administrative law judge’s decision in very limited circumstances. One such circumstance is that the underlying statute, regulation, or by-law which formed the basis for punishment is unconstitutional and invalid, either “on its face” or “as applied.”  A reviewing court may overrule the findings if the agency investigating the allegations of wrongdoing had no jurisdiction to do so. The court may also overturn the decision if the administrative law judge failed to decide every issue required for resolution of the entire matter. If the investigating agency follows an illegal investigatory procedure or fails to follow proper procedure, then the decision may be overturned. Likewise, if the persons investigating the wrongdoing were not properly authorized to do so then the decision may be overturned. Furthermore, if the agency action is based upon a “determination of fact” of which there is no evidence and the fact is “substantial” to the determination of the issue. Lastly, the reviewing court may overturn the administrative law judge’s decision if the decision is arbitrary or capricious.

The district court’s decision may also be appealed. An appellate court will review a lower court’s decision to ensure that the district court limited its review strictly to the issues permitted. In that sense, an appellate court will undertake a similar review of the record as the district court. The appellate court is limited to the same areas of inquiry as the district court.

Do Not Try To Navigate These Choppy Waters Alone

Kansas Professional Licensing Attorney Danielle Sanger has vast experience in representing numerous professional licensees who face disciplinary action. Attorney Sanger is keenly aware of the sacrifice and determination required in obtaining a professional license. Adversary proceedings against a professional license are complicated and confusing. Contact Kansas professional licensing attorney Danielle Sanger today at 785-979-4353 to schedule your free consultation.

Missouri Licensing Board Endeavors To Make Our Buildings Safe

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The Missouri Board of Architecture, Engineers, Land Surveyors, and Landscape Architects (“the Board”) provides an invaluable service to the public. The Board ensures that the professionals who plan and construct the buildings in which we live, work, and play are competent and properly licensed. The Board establishes the ethical duties of its member licensees as well as the code of conduct for its members. Missouri professional licensing attorney Danielle Sanger represents licensees who are being investigated by the Board for conduct they claim falls below their standards.

The Board was created by the Missouri legislature with the mandate of ensuring the structural integrity of Missouri’s buildings. The statute confers the power to the Board to issue licenses to practice as an architect, engineer, land surveyor, or landscape architect. The statute also bestows the authority upon the Board to discipline those licensees. After investigation into allegations of wrongdoing, the Board may file a complaint with Missouri’s administration hearings commission to seek adjudication of the allegations. There are numerous reasons for which a complaint may be filed. These reasons are not arbitrary but rather bare directly upon whether the licensee is competent to perform in his or her profession. Alcohol and/or drug use that impairs the ability of the licensee to competently perform may be disciplined. A conviction in state or federal court, or a plea of nolo contendre, that relates to the ability to function in the profession or an adjudication of a crime involving fraud or deceit, or an act of violence may be disciplined, even if a sentence is not imposed. Engaging in any fraud, deceit, bribery, or misrepresentation may also be disciplined.  Similarly, incompetence, gross negligence or misconduct while performing the duties of a licensee may be punished. Adverse license action may also be taken for holding oneself out as a licensee without holding a valid license or assisting a person in that capacity. Further still, violations of the public trust, false or misleading advertising, failing to properly display a license, or being disciplined by another licensing authority will subject the licensee to a facing a disciplinary complaint. Lastly, being adjudicated incompetent or disabled by a court will cause the licensee to face adverse action.

The Board has the discretion to mete out punishment as prescribed by law. The statute provides for various forms of punishment, including censure or probation. The probationary term may not exceed 5 years and may include terms designed to prevent further ethical violations. The Board may also take more serious action. The Board can levy a fine or suspend practice for up to 3 years. Most significantly, the Board may revoke a license to practice in one of the named professions. In fact, the Board has revoked approximately 47 licenses as of November 20, 2015. Furthermore, there are currently eight licensees on probation and none on suspension. However, 10 licensees are listed as suspended for failure to pay taxes. That status is known as a “House Bill 600” suspension.

Licensees must comply with the statutory grounds to remain in good standing with the Board, and they also must follow the Code of Professional Conduct.  The Board has the authority to make regulations, such as the Code of Professional Conduct, to maintain public trust in the profession. Any violation of the Code of Professional Conduct may result in the Board filing a complaint for discipline. The Code of Professional Conduct requires licensees to act with “reasonable care and competence” and to “apply technical skill” required of architects, engineers, land surveyors, and landscape architects.  Additionally, these professionals are to avoid self-dealing and represent themselves to the degree they are trained and educated.

Call For More Information

If you are an architect, engineer, land surveyor, or landscape architect and you are facing discipline, call Missouri Professional Licensing Attorney Danielle Sanger. Attorney Sanger has the experience to vigorously represent you based upon successfully representing professional licensees as well as her experience as an assistant attorney general. Call Missouri professional licensing attorney Danielle Sanger today at 785-979-4353 to schedule your free, no-obligation consultation. Learn the difference experience and determination will make for you.

Kansas Professional License Defense Lawyer Asks: Homicide or Compassionate Care?

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In Kansas, a physician can be tried for murder for over-administering painkillers designed to relieve chronic and/or acute pain. From a pure ethical prospective, palliative care must not be denied to a suffering patient. Over-prescribing, with the intent to kill, however, may cross the line of sound medical ethics to murder. This intersection of medical ethics and criminal jurisprudence can result in a conflation of the healthcare professionals’ duties toward their patients. Accordingly, the highest attention and consideration must be given to the decision to administer higher doses of painkilling prescriptions that could cause an overdose, resulting in premature death. Such a decision can adversely affect licensing privileges as well as criminal responsibility. Attorney Danielle Sanger has years of experience defending medical professionals in licensing actions and promises to vigorously defend your license from adverse action by the State Board of Healing Arts.

Healthcare professionals are well versed in the six core values of medical ethics. Palliative care, according to the Indian Journal of Palliative Care, implicates the ethical mandates of patient autonomy, beneficence, or non-malfeasance, and justice.  Thus, healthcare professionals must counsel a patient facing end-of-life decisions resulting from terminal illness to guide them in making informed choices over their care to the extent possible.   This is especially true with regard to pain management.  The author of the article argues that pain management and relief is a basic “human right.”

No one truly wants to see their loved one suffer, especially when the patient is terminal. Since physicians are not trained to end a life, administering a high dose of narcotics to sedate, or even cause a fatal overdose, could lead to licensing sanctions as well as a criminal prosecution depending upon the physician’s intent.  This is a fine line. Kansas’s legislature passed a statute barring so-called “mercy killings” and prohibits any act or omission that ends a life in a manner inconsistent with the “natural process of dying.”

This fine line was tested in the case of State v. Naramore, wherein the Kansas Supreme Court reversed a physician’s conviction for attempted murder of a terminally ill cancer patient. Dr. Naramore administered high doses of pain killers. Dr. Naramore administered these high doses to combat the substantial pain from which his patient was suffering. The doctor, as well as the patient’s family, observed that the patient’s heart rate and respiration slowed subsequent to ingesting the pain medication. The administration of the medication resulted in a “double effect,” that is, the relief of excruciating pain through high doses of drugs, which, by virtue of the high doses, hastened death while primarily relieving pain.

The Kansas Supreme Court reversed the conviction. The Court recognized that the American Medical Association took the position that administering high doses of medication to combat pain was medically appropriate despite the effect of the drug “shortening life.” The Court noted that there is a fine line between a physician offering palliative care and euthanasia. Palliative care is designed to administer medication to relieve pain, which may then cause death. Conversely, euthanasia is the administering of medication to cause death and thereby eliminate suffering. More to the point, the Court cited the Kansas Association on Osteopathic Medicine’s opinion that failure to administer pain medication that causes a patient to suffer unbearable pain is “medical malpractice.” In the final analysis, the Court held that based upon all of the evidence heard at trial, much of which was from competing experts, Dr. Naramore was entitled to an acquittal.

Contact A Medical Licensing Attorney For Guidance

If you are a medical professional facing these difficult decisions, consulting Attorney Danielle Sanger, who has vast experience in licensing matters, can help. Kansas Professional Licensing Defense Lawyer Danielle Sanger has committed her career to vigorously fighting to protect the professional licenses of medical professionals in Kansas and Missouri. Call Attorney Danielle Sanger at 785-979-4353 today for a free, no-obligation consultation.